Gout and Rheumatoid Arthritis Flashcards
Definition of Gout
Deposition of urate crystals in fibrous tissue of synovial joints after years of hyperuricemia.
Disorder of purine metabolism and excretion
Purine metabolism
purines are metabolized to uric acid which is barely soluble in plasma.
Decreasing the solubility of urate can promote crystal deposition.
Inflammatory response to urate crystals
Activated neutrophils cause a positive feedback loop of cytokine release, endothelial activation and more neutrophils.
The 4 stages of Gout
- Asymptomatic hyperuricemia
- Acute gout
- Intercritical phase
- Chronic gout
Drugs for Gout
Acute: NSAIDs, Steroids, Colchicine
Chronic: Allopurinol, Probenecid
ASA Contraindicated!!
Colchicine
Class: for acute gout
Mechanism of action: arrests mitosis in metaphse by binding to the microtubular protein and preventing spindle formation
Indication:
Pharmacological effects: inhibits neutrophil migration and phagocytic activity in inflamed joints. inhibits the inflammatory response by inhibiting neutrophil activation/motility and adhesion
oAdverse effects you have to consider: Diarrhea
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Allopurinol (Zyloprim)
Class: decrease uric acid synthesis
Mechanism of action: oxidized to oxypurinol. Oxypurinol’s elimination t1/2 much longer. Non-competitive inhibitor of xanthene oxidase (which turns xanthene into uric acid). Decreases the biosynthesis of uric acid
Indication: chronic gout therapy
Pharmacological effects:
How this drug might effect dental treatment of patient
oAdverse effects you have to consider:
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Probenecid
Class: increase uric acid secretion
Mechanism of action: inhibits the basolateral anion exchanger of the proximal tubule. blocks tubular reabsorption of urate, decreasing the concentration of urate in the plasma. Development of urate stones in kidney or ureter. .
Indication: chronic gout therapy
Pharmacological effects: Makes urine more acidic by co-administration of calcium citrate
How this drug might effect dental treatment of patient
Adverse effects you have to consider: sore gums
oContraindicated drugs:
oContraindications:
oWhich analgesic can the patient take:
Definition of Rheumatoid Arthritis
Inflammation of the synovium of the joints.
Synovium thickens and release of enzymes that digest bone and cartilage.
Disease Modifying Anti-rheumatic Drugs (DMARDS)
Alter the progression of the disease.
(gold compounds, antimalarial compounds, penicillamine, sulfasalazine)
Etanercept (Enbrel)
Soluble TNF receptor dimer Soluble receptor that floats in the body and when it encounters tnf alpha, it will bind to tnf alpha and not let it bind to actual receptor •Improve symptoms, do not cure disease •Increased risk for •TB •Invasive fungal infections •Sepsis •CNS demyelination
Infliximab (Remicade)
Monoclonal antibodies consisting of the ligand binding protion of the TNFalpha receptor. •Improve symptoms, do not cure disease •Increased risk for •TB •Invasive fungal infections •Sepsis •CNS demyelination
